Provider Demographics
NPI:1700056652
Name:WILLIAM D LOVELADY DPM PA
Entity Type:Organization
Organization Name:WILLIAM D LOVELADY DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOVELADY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM PA
Authorized Official - Phone:210-614-3155
Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:SUITE 610
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-614-3155
Mailing Address - Fax:210-614-3156
Practice Address - Street 1:8042 WURZBACH RD
Practice Address - Street 2:SUITE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3818
Practice Address - Country:US
Practice Address - Phone:210-614-3155
Practice Address - Fax:210-614-3156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0533213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018634801Medicaid
TXT14486Medicare UPIN
TX018634801Medicaid